MEDICARE: THOMAS RUDENKO CHIROPRACTIC CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NR0400X	Rehabilitation Chiropractor	DC26132	CA

General Provider Information

NPI Number	:	1821149071
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS RUDENKO CHIROPRACTIC CORPORATION

Provider Business Mailing Address
First Line	:	11311 VENTURA BLVD
Second Line	:
City	:	STUDIO CITY
State	:	CA
Zip	:	91604-3138
Country	:	US
Telephone Number	:	818-762-4149
Fax Number	:	818-762-4189

Provider Business Practice Location Address
First Line	:	11311 VENTURA BLVD
Second Line	:
City	:	STUDIO CITY
State	:	CA
Zip	:	91604-3138
Country	:	US
Telephone Number	:	818-762-4149
Fax Number	:	818-762-4189

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. THOMAS MICHAEL RUDENKO
Credential	:	D.C.
Telephone Number	:	818-762-4149

Provider Enumeration Date	:	01/15/2007
Last Update Date	:	08/22/2020

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